Intra-articular therapy in osteoarthritis

• Published in: Postgraduate medical journal 2003-08, Vol.79 (934), p.449-453
• Main Authors: Uthman, I, Raynauld, J-P, Haraoui, B
• Format: Article
• Language: English
• Subjects: Adjuvants, Immunologic - administration & dosage; Adrenal Cortex Hormones - administration & dosage; Adrenocortical hormones; Analgesics - administration & dosage; Analysis; Arthritis; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Care and treatment; Cell adhesion & migration; corticosteroids; Cytokines; Gene expression; Health aspects; Humans; Hyaluronic acid; Hyaluronic Acid - administration & dosage; Injections, Intra-Articular; intra-articular therapy; kilodalton; Knee; Medical research; Medical sciences; Medicine, Experimental; Methods; methylprednisolone acetate; MPA; NaPP; non-steroidal anti-inflammatory drugs; NSAIDs; Osteoarthritis; Osteoarthritis, Knee - drug therapy; Pain - prevention & control; Pain management; Pharmacology. Drug treatments; Physiological aspects; Review; Rheumatology; sodium pentosan polysulfate; Western Ontario and McMaster Universities Osteoarthritis Index; WOMAC
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/pmj.79.934.449

The medical literature was reviewed from 1968–2002 using Medline and the key words “intra-articular” and “osteoarthritis” to determine the various intra-articular therapies used in the treatment of osteoarthritis. Corticosteroids and hyaluronic acid are the most frequently used intra-articular therapies in osteoarthritis. Other intra-articular substances such as orgotein, radiation synovectomy, dextrose prolotherapy, silicone, saline lavage, saline injection without lavage, analgesic agents, non-steroidal anti-inflammatory drugs, glucosamine, somatostatin, sodium pentosan polysulfate, chloroquine, mucopolysaccharide polysulfuric acid ester, lactic acid solution, and thiotepa cytostatica have been investigated as potentially therapeutic in the treatment of arthritic joints. Despite the lack of strong, convincing, and reproducible evidence that any of the intra-articular therapies significantly alters the progression of osteoarthritis, corticosteroids and hyaluronic acid are widely used in patients who have failed other therapeutic modalities for lack of efficacy or toxicity. As a practical approach for a knee with effusion, steroid injections should be considered while the presence of symptomatic “dry” knees may favour the hyaluronic acid approach. The virtual absence of serious side effects, coupled with the perceived benefits, make these approaches attractive.